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Suffering in Silence: Pathways to Grace

by Sandy Christiansen, MD, FACOG
Today's Christian Doctor - Fall 2011

Sarah's Story

Sarah’s life couldn’t be going any better. She was graduating high school in a few months and had landed a four-year athletic scholarship to college to play the sport she loved — soccer. The man she loved was also matriculating to the same college and there was talk of marriage. When she skipped a period, she chalked it up to stress. It wasn’t until she missed a second period that she became alarmed and took a home pregnancy test. In the short time it took for the second line to appear indicating a positive test, Sarah’s perfect life came crashing down.

Confused panic enveloped her and made thinking clearly impossible. All she knew was that she just couldn’t have a baby right now. What would her parents say? What about the scholarship she had worked so hard for? Her career would be over; she’d let everybody down. Sarah had always been opposed to abortion, but now she felt trapped and frightened. As if it were someone else making the decision, she rationalized that she had no choice; she had to abort. Her boyfriend didn’t argue with her, voicing that it was her body and he would support whatever decision she made.

The abortion clinic recommended the medical abortion, stating it was more “natural, just take a few pills and the ‘tissue’ passes much like a miscarriage.” She was unprepared for the amount of cramping and bleeding that she experienced, but was too afraid to tell her parents. Just when the cramping became unbearable, she felt something pass out of her body. The horror of her decision came crashing through her well-constructed wall of denial when she saw the tiny embryo floating in the toilet.

In the coming weeks and months, numbness replaced the pain which Sarah unwittingly had stuffed way down. During college, using alcohol to excess became the norm, as did purging to maintain her weight for soccer. She and her boyfriend split up, less than a year after the abortion. Sarah started experiencing panic attacks and continued to self-medicate with alcohol. She eventually got married and had a baby, but suffered a severe bout of postpartum depression. It would be years before she would put the pieces together, understand the impact of her abortion and begin the path towards healing.

(Fictitious character based upon real stories.)

How many Sarah’s have you seen in your office? You’ve met them, you just may not have recognized them. Stories like hers are shared daily in pregnancy resource centers (PRCs) across the country and serve as a sad and frightening legacy to abortion. According to the Guttmacher Institute, it is estimated that more than 43 million abortions were performed in the U.S. between 1973 and 2003.1

How have women who made the choice to have an abortion fared? The cold reality is that many individual lives have been psychologically devastated as a consequence of choosing abortion. As Christian physicians, we must be able to identify the psychological impact of abortion in our patients’ lives and be ready to point them in the direction of health and healing.

An ever-growing body of literature reveals a host of long-term health risks associated with induced abortion. Chief among the potential risks are psychological problems. According to Dr. Priscilla Coleman, Professor of Human Development and Family Studies at Bowling Green State University, hundreds of studies documenting abortion as a significant risk factor for mental health problems have been published in premier psychology and peer-reviewed medical journals over the last two decades. Sufficient data is available in the scientific literature to conclude that induced abortion substantially increases the risk of anxiety, depression, substance use, suicide ideation and suicide. Induced abortion is implicated in 11 percent of cases of panic disorder, 13 percent of cases of alcohol dependence and 16 percent of cases of bipolar disorder.2 In light of the approximately 2 million abortions performed in the U.S. each year, this issue represents a significant public health concern.

Sarah’s life is full of the psychological fallout that can be associated with an abortion decision. Substance abuse, relationship problems, eating disorders, anxiety, depression and suicide have all been linked to induced abortion.3,4,5,6,7 Women are not the only ones affected, as men also regret the abortion and suffer from the fallout.8

My residency training in obstetrics and gynecology provided no education about the negative impact of abortion. I first learned about how abortion affects women through my volunteer work with a crisis pregnancy center. I began to gently ask my patients about their past abortions. For many, it was clear that this was a painful subject, one that they had seldom spoken of as the memory was still raw. Others were matter of fact in their responses, until asked if they had experienced any depression or other struggles; then the tears would flow. The local pregnancy center was a great resource. At the center, I was confident they would experience the love of Christ and receive the needed care to heal from their abortion. As physicians, we are uniquely positioned to hear our patients’ secret pain, to validate their feelings and to set them on the path to healing.

The first step is learning to recognize post-abortion symptoms in our patients, both male and female. If you are not in the habit, start asking about past abortions along with the reproductive health history. Ask for details about the abortion, just as you would a full-term pregnancy. How far along? Was it a surgical or medical procedure? Were there any immediate complications? Ask specifically, if they experienced feelings of depression or anxiety, or suicidal thoughts. Don’t be surprised by sudden tears; you may be the first person to ever ask about the experience. You may be the only person she’s ever told. Many of these men and women shoulder enormous guilt. Your compassionate, nonjudgmental approach will literally be a balm for their wounded spirits. Don’t be fooled by the typical “I’m fine” response. For those who deny any post-abortion issues, give them a list of signs and symptoms to look out for, as well as a list of helpful websites. Over time, the suppressed pain may start manifesting and this list may be a lifesaver.

While you won’t find “postabortion stress” in the DSM-IV, you will want to look for and be able to recognize the following symptoms in your patients who report a prior abortion:

  • guilt
  • anniversary syndrome
  • flashbacks
  • avoidance of babies, pregnant people, etc.
  • substance abuse
  • eating disorders
  • anxiety and/or depression
  • difficulty bonding with a child or partner

By identifying these factors and raising the possibility of a connection with her abortion, you may be helping to release her from the prison that has held her captive. Be aware that she may not be ready to pursue healing. For those who are, the following are some of the resources available. While secular efforts may bring some degree of healing, true healing is only achieved when the relationship with God is reconciled.

  1. Care Net is a Christian organization that provides support to more than 1,200 PRCs which offer hope to those facing unplanned pregnancies by providing practical help and emotional support. Care Net’s PRCs are uniquely equipped to minister to women who are suffering emotionally and spiritually after an abortion. Postabortion recovery Bible studies such as Linda Cochrane’s “Forgiven and Set Free” have provided the necessary support to experience true healing and forgiveness for hundreds of women. As a medical director of a PRC, I have met many centers truly are sanctuaries where captives are set free from the pain of past abortions. To find a Care Net PRC near you, call 800-395-HELP or go to
  2. Weekend retreats at Rachel’s Vineyard offer a supportive, confidential and nonjudgmental environment where women and men hurt by abortion can begin the process of restoration, renewal and healing. For more information and to find a retreat center, go to
  3. Ramah International is a Christian ministry dedicated to helping individuals heal after abortion. Written by Ramah’s education staff and Sydna Masse, “Her Choice to Heal: Finding Spiritual and Emotional Peace after Abortion,” is another resource.
  4. Silent No More is a Christian group seeking to expose and heal the secrecy and silence surrounding the emotional and physical pain of abortion. Men and women make public their stories of the devastation abortion caused and give voice to the scientific data supporting the negative psychological impact of abortion. To find an abortion aftercare group near you, go to

For women and men hurt by abortion, the words of Psalm 39:2 describe their suffering, “So I remained utterly silent . . . But my anguish increased” (NIV 2011). As we identify patients who are struggling with a past abortion, compassionately hear their stories and point them to Jesus, we will be giving them “streams in the wasteland” and hope for a brighter tomorrow.9


1 Finer LB, Henshaw SK, Estimates of U.S. Abortion Incidence, 2001–2003. Guttmacher Institute August 3, 2006;, accessed February 20, 2011.

2 Coleman PK, Coyle CT, et al. Induced abortion and anxiety, mood, and substance abuse disorders: Isolating the effects of abortion in the national comorbidity survey; J Psychiatr Res 2009; 43, 770–776.

3 Fergusson DM, et al. Abortion in young women and subsequent mental health. J of Child Psychology and Psychiatry 2006; 47(1): 16-24

4 Pedersen, W. (2007). Childbirth, abortion and subsequent substance use in young women: a population-based longitudinal study. Addiction, 102 (12), 1971-78.

5 Coleman PK, et al, Predictors and Correlates of Abortion in the Fragile Families and Well-Being Study: Paternal Behavior, Substance Use, and Partner Violence;; Int J Ment Health December 2008

6 Coleman, P.K., Coyle C.T, Shuping M., Rue V.M. (2009). Induced abortion and anxiety, mood, and substance abuse disorders: Isolating the effects of abortion in the National Comorbidity Survey. J Psychiatr Res 2009; 43, 770–776.

7 Gissler M, et al, Injury deaths, suicides and homicides associated with pregnancy; European J of Public Health, Vol. 15, No. 5, 459-463; 2005.

8 Condon G, Hazard D, Fatherhood Aborted, Tyndale 2001.

9 New International Version 1984, Isaiah 43:19.


Sandy Christiansen, MD, FACOG

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